20230992 Ver 1_Agent Authorization Form Nebitt-Wilson-Bradshaw Etc Cane Creek[37]_20230712

7 Samuel Ashe Drive, Asheville, NC 28805 1 919-600-4790 1 [e-mail]
AGENT AUTHORIZATION FORM
Project Name: Nesbitt -Wilson -Bradshaw, etc. Cane Creek Restoration
Project Address/Location: 6,000 If reach of Cane Creek (35.47529,-82.43928)
Fletcher, NC
The undersigned is the
Property Owner ✓
Assigned
Representative
0
Easement
Holder 11
Right -Of -
Way Holder
Lease Holder
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and will be the applicant on the request for permit(s) and/or jurisdictional determination. I
hereby authorize Jennings Environmental PLLC to act on my behalf and take all actions
necessary for the processing, issuance, and acceptance of the permit or certification and any
and all standard and special conditions attached. Additionally, I authorize the representative(s)
of the permitting agency(s) to enter the property for the purpose of conducting activities
associated with verification of the request for permit(s) and/or jurisdictional determination. I
hereby certify that the information submitted in this document is true and accurate to the best
of our knowledge.
Name:
Company Name
(if applicable):
Mailing Address
Phone Number
Email Address:
Signature
Debbie Dodson
Resource Institute, Inc.
Winston-Salem, NC 27106
336-750-0522
ddodsonctr resourceinstituteinc.org
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Date: 03/01 /2023
Check if applicable
❑✓ The property owner has executed a binding agreement with the Natural Resources Conservation
Service (NRCS) for this stream/wetland restoration project. The above is the assigned representative
for the NRCS and is authorized to act on behalf of the NRCS and the property owner through a signed
mutual agreement for the stream sabiIization/restoration project.
Jennings Environmental PLLC is licensed with the North Carolina Board of Examiners for Engineers and Surveyors and is
authorized to practice engineering under the provisions of Chapter 89C and 55B of the General Statutes of North Carolina.
License Number P-1932.